acalasia 2013
TRANSCRIPT
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ACALASIA
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ACALASIA
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ACALASIA
TRASTORNO MOTOR CARACTERIZADO POR AUMENTO DE LA PRESION BASAL DEL E.E.I.,RELAJACION INCOMPLETA DE ESTE ULTIMO DURANTE LA DEGLUCION Y APERISTALTISMO DEL CUERPO ESOFAGICO
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ETIOLOGIA
IDIOPATICO
ASOCIADO A DIABETES,ENF. DE
CHAGAS, CANCER Y VAGOTOMIA
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ALTERACIONES NEUROANATOMICAS
PERDIDA DE CELULAS GANGLIONARES DEL PLEXO DE AUERBACH
DEGENERACION DEL NERVIO VAGO
CAMBIOS CUANTITATIVOS Y
CUALITATIVOS DE LAS NEURONAS DEL NUCLEO
MOTOR DORSAL DEL VAGO
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ACALASIA
INCIDENCIA: 0.5 X 100,000 hab
ENTRE LOS 25 Y 60 AÑOS
HOMBRES-MUJERES 1:1
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MANIFESTACIONES CLINICAS
DISFAGIA PROGRESIVA A SOLIDOS Y LIQUIDOS
DISFAGIA LEVE E INTERMITENTE AL PRINCIPIO
REGURGITACION DE ALIMENTOS NO DIGERIDOS
ARDOR RETROESTERNAL POR FERMENTACION ACIDA DE ALIMENTOS
SIBILANCIAS Y TOS
PERDIDA DE PESO
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DIAGNOSTICO
TELE DE TORAX
ESOFAGOGRAMA
ENDOSCOPIA
MANOMETRIA
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TELE DE TORAX
ENSANCHAMIENTO DEL MEDIASTINO
NIVELES HIDROAEREOS
CAUSADOS POR LA RETENCION DE
ALIMENTOS FERMENTADOS
AUSENCIA DE BURBUJA AEREA EN
EL ESTOMAGO
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ESOFAGOGRAMA
ESOFAGO DILATADO y/o TORTUOSO
SIN PERISTALSIS
ALIMENTOS RETENIDOS
POBRE VACIAMIENTO
TERMINACION EN PUNTA DE LAPIZ O PICO DE PAJARO
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ENDOSCOPIA
• INDISPENSABLE PARA DESCARTAR LA PSEUDOACALASIA DEBIDA A CANCER DE LA UNION ESOFAGOGASTRICA
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PSEUDOACALASIA DEBIDA A CANCER ESOFAGICO
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MANOMETRIA
CONFIRMA EL DIAGNOSTICO
AUSENCIA DE PERISTALSIS
CONTRACCIONES SIMULTANEAS DE ENTRE
10 Y 40 mm Hg
RELAJACION INCOMPLETA DEL E.E.I.
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TRAZO MANOMETRICO TIPICO DE ACALASIA
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TRATAMIENTO
OBJETIVO: DISMINUIR LA ELEVADA PRESION DEL E.E.I.
SI EL VACIAMIENTO MEJORA, LA ESTASIS Y SUS COMPLICACIONES DISMINUYEN
LA PERISTALSIS NO SE RECUPERA
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OPCIONES TERAPEUTICAS
FARMACOLOGICO
DILATACIONES
CIRUGIA
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FARMACOLOGICO
DINITRATO DE ISOSORBIDE (5-10 mg)
NIFEDIPINA (10-20 mgs)
DISMINUYEN LA PRESION DEL E.E.I. DURANTE 90 min
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TOXINA BOTULINICA
INYECTADA LOCALMENTE
HASTA UN AÑO DE ACCION
MEJORIA EN UN 66% EN SEIS MESES
33% NO FUNCIONA
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Botulinum Toxin Type A (Botox Cosmetic) is a protein complex produced by the bacterium Clostridium botulinum, which contains the same toxin that causes food poisoning. When used in a medical setting as an injectable form of sterile, purified botulinum toxin, small doses block the release of a chemical called acetylcholine by nerve cells that signal muscle contraction
LA INHIBICION DE LA LIBERACION DEACETILCOLINA POR BOTOX CONTRARRESTA ELDESEQUILIBRIO DE EXCESO DE ESTIMULACIONCOLINERGICA RESPONSABLE DE MANTENERLA CONTRACCION DEL E.E.I. E IMPEDIR SURELAJACION
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DILATACIONES
PASIVAS: DILATADORES DE HURST (50-60 Fr)
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DISTINTOS TIPOS DE DILATADORESRIGIDOS Y DE BALON
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DILATADORES RIGIDOS
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DILATACION NEUMATICA
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DILATADOR DE BALON
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TRATAMIENTO QUIRURGICO
CARDIOMIOTOMIA DE HELLER: consiste en hacer una insición a nivel de la UEG, para cortar las fibras musculares y disminuir la presión del
E.E.I.
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